New Mexico Administrative Code
Title 8 - SOCIAL SERVICES
Chapter 301 - MEDICAID GENERAL BENEFIT DESCRIPTION
Part 5 - MEDICAL MANAGEMENT
Section 8.301.5.11 - IDENTIFICATION OF CANDIDATES

Universal Citation: 8 NM Admin Code 8.301.5.11

Current through Register Vol. 35, No. 18, September 24, 2024

All medicaid recipients are potential candidates for inclusion in medical management, whether enrolled in Salud! or covered under medicaid fee-for-service.

Recipients are identified as candidates for review by HCA, the MCO, a provider or other appropriate entities. The following situations may indicate a need for medical management:

A. individuals who overutilize medical services;

B. individuals who are habitually non-compliant and miss appointments, or who frequently seek unauthorized treatment or care; and

C. individuals who frequently change PCPs or simultaneously utilize multiple pharmacy providers;

D. individuals who regularly utilize emergency room services for inappropriate, nonemergency care.

Disclaimer: These regulations may not be the most recent version. New Mexico may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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